Average Medicaid Upper Endoscopy (EGD) Payments
Typical Medicaid Upper Endoscopy (EGD) reimbursement across 2,153 cities
Avg. Medicaid Paid
$251.83
Price Range
$0.00 – $1,810
Total Claims
5.9M
Cities
2153
Typical Payment Range
Typical Medicaid Upper Endoscopy (EGD) payments fall between $76.12 and $225.09 per claim (median: $127.97). The top 10% of payments exceed $381.16.
Based on per-provider averages across all Medicaid claims in this category.
About This Procedure
Upper endoscopy examines the lining of the esophagus, stomach, and first part of the small intestine using a thin, flexible tube with a camera.
Why do these costs look low?
These figures represent Medicaid reimbursement rates — the amounts that state Medicaid programs actually paid providers. Medicaid typically reimburses significantly less than private insurance or out-of-pocket prices. If you have private insurance or are paying cash, expect higher costs. See the cost components below for per-code averages.
Costs by City
| City | Avg. Paid | Min / Max | Claims | Providers |
|---|---|---|---|---|
| Jamaica, NY | $175.93 | $26.82 – $455.95 | 297 | 4 |
| West Des Moines, IA | $282.86 | $282.86 – $282.86 | 296 | 1 |
| Seneca, PA | $119.91 | $119.91 – $119.91 | 295 | 1 |
| Iron Mountain, MI | $303.86 | $303.86 – $303.86 | 295 | 1 |
| Holmdel, NJ | $1,002 | $913.24 – $1,144 | 294 | 2 |
| Coudersport, PA | $429.29 | $429.29 – $429.29 | 293 | 1 |
| Rock Island, IL | $83.06 | $83.06 – $83.06 | 292 | 1 |
| Williamsport, PA | $143.33 | $135.65 – $148.21 | 291 | 2 |
| Kinston, NC | $79.60 | $45.99 – $162.95 | 291 | 5 |
| Sarasota, FL | $106.99 | $40.51 – $207.16 | 290 | 4 |
| Galion, OH | $224.57 | $199.96 – $365.41 | 289 | 2 |
| Sylvania, OH | $108.41 | $93.98 – $139.33 | 287 | 4 |
| Blackfoot, ID | $351.65 | $351.65 – $351.65 | 287 | 1 |
| Mission Hills, CA | $67.55 | $14.18 – $85.76 | 287 | 2 |
| Truckee, CA | $89.05 | $89.05 – $89.05 | 286 | 1 |
| Gresham, OR | $375.95 | $375.95 – $375.95 | 285 | 1 |
| Stevens Point, WI | $169.48 | $59.51 – $174.78 | 283 | 2 |
| Durham, NC | $152.81 | $54.93 – $251.10 | 279 | 5 |
| Indiana, PA | $108.16 | $88.53 – $109.04 | 279 | 2 |
| Suffolk, VA | $93.52 | $76.37 – $190.54 | 278 | 6 |
| Shelbyville, IN | $460.96 | $460.96 – $460.96 | 277 | 1 |
| Seymour, IN | $693.71 | $693.71 – $693.71 | 277 | 1 |
| Attleboro, MA | $764.68 | $61.60 – $890.33 | 277 | 2 |
| Methuen, MA | $152.42 | $59.15 – $524.47 | 275 | 3 |
| Du Bois, PA | $73.06 | $72.00 – $94.29 | 275 | 2 |
| West Nyack, NY | $301.06 | $255.35 – $357.22 | 275 | 5 |
| Oakhurst, NJ | $328.20 | $259.54 – $441.51 | 273 | 4 |
| Wellington, FL | $37.29 | $37.29 – $37.29 | 272 | 1 |
| Rockledge, FL | $56.02 | $56.02 – $56.02 | 272 | 1 |
| Pasadena, TX | $196.16 | $196.16 – $196.16 | 271 | 1 |
| Burgettstown, PA | $67.67 | $67.67 – $67.67 | 270 | 1 |
| Olean, NY | $745.86 | $71.11 – $777.37 | 269 | 2 |
| Mt Pleasant, PA | $108.41 | $108.41 – $108.41 | 268 | 1 |
| Rockwall, TX | $54.40 | $54.40 – $54.40 | 268 | 1 |
| Shawano, WI | $795.22 | $212.36 – $829.78 | 268 | 2 |
| West Palm Beach, FL | $28.63 | $23.11 – $30.91 | 267 | 2 |
| Lone Tree, CO | $142.85 | $93.38 – $250.01 | 267 | 4 |
| Duarte, CA | $97.13 | $43.11 – $354.29 | 265 | 7 |
| Yuba City, CA | $22.64 | $3.55 – $23.55 | 264 | 2 |
| Saint Cloud, FL | $108.85 | $108.85 – $108.85 | 262 | 1 |
| Columbia, MS | $82.01 | $82.01 – $82.01 | 262 | 1 |
| Bridgewater, NJ | $285.20 | $249.33 – $307.25 | 260 | 2 |
| Bladensburg, MD | $78.43 | $78.43 – $78.43 | 260 | 1 |
| Linwood, NJ | $134.22 | $134.22 – $134.22 | 259 | 1 |
| Rockaway, NJ | $180.44 | $177.86 – $219.74 | 259 | 2 |
| North Miami Beach, FL | $135.18 | $28.49 – $586.66 | 254 | 3 |
| Wildomar, CA | $114.33 | $114.33 – $114.33 | 253 | 1 |
| Lincoln, NE | $67.07 | $45.69 – $80.76 | 253 | 6 |
| Beaufort, SC | $13.99 | $6.20 – $52.53 | 253 | 3 |
| Maryville, IL | $179.90 | $179.90 – $179.90 | 253 | 1 |
Cost Components
National averages for each billing code in this procedure category. Sorted by claim volume.
| Code | Description | Avg. Paid | Claims | Providers |
|---|---|---|---|---|
| 43239 | EGD w/biopsy upper GI | $253.86 | 5,956,836 | 9,455 |
| 43235 | EGD diagnostic upper GI | $254.50 | 202,728 | 958 |
| 43248 | EGD w/dilation guide wire | $140.00 | 59,963 | 186 |
| 43249 | EGD w/balloon dilation | $350.47 | 27,932 | 155 |
| 43251 | EGD w/snare removal | $247.77 | 8,994 | 30 |
| 43255 | EGD w/control bleeding | $475.08 | 7,407 | 9 |
| 43246 | EGD w/PEG tube placement | $137.82 | 3,019 | 30 |
| 43237 | EGD w/endoscopic us | $308.70 | 2,887 | 33 |
| 43250 | EGD w/tumor removal | $258.39 | 2,380 | 11 |
| 43244 | EGD w/band ligation | $253.62 | 1,697 | 25 |
| 43236 | EGD w/submucosal injection | $37.02 | 1,037 | 6 |
| 43245 | EGD w/dilation stricture | $91.88 | 1,020 | 10 |
| 43247 | EGD w/foreign body removal | $93.65 | 915 | 11 |
| 43252 | EGD w/optical endomicroscopy | $166.89 | 722 | 10 |
| 43254 | EGD w/endo mucosal resection | $164.97 | 472 | 2 |
| 43242 | EGD w/us guided inj/asp | $234.58 | 258 | 9 |
| 43253 | EGD w/injection sclerosis | $179.99 | 161 | 4 |
| 43238 | EGD w/us guided needle bx | $618.60 | 13 | 1 |
| 43241 | EGD w/tube/catheter | $91.14 | 13 | 1 |
| 43240 | EGD w/drainage pseudocyst | — | — | — |
| 43243 | EGD w/injection varices | — | — | — |
These averages group common billing codes used when providers bill Medicaid for this procedure. Individual costs will vary.